The Sports Docs Podcast
Sports medicine is a constantly evolving field, with hundreds of new articles published each month on the topic. This ever-growing wealth of information can make it challenging to stay updated on the newest approaches and techniques, and to know which data should actually change your practice. Join orthopedic surgeons, Dr. Catherine Logan and Dr. Ashley Bassett, as they chat about the most recent developments in sports medicine and dissect through all the noise.
On each episode of The Sports Docs podcast, the hosts will tackle a specific injury – from ACL tears to shoulder instability – and review the top research from various high-impact journals that month, including The American Journal of Sports Medicine, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Sports Health, Journal of Shoulder and Elbow Surgeons, and more. The Sports Docs will also be joined by experts in the field of sports medicine – orthopedic surgeons, nonoperative sports medicine specialists, athletes, physical therapists, athletic trainers and others – to provide a fresh and well-rounded perspective based on their unique experiences.
The Sports Docs – Dr. Logan & Dr. Bassett – are friends & former co-residents from the Harvard Combined Orthopaedic Residency Program, who went onto esteemed sports medicine fellowships at The Steadman Clinic and The Rothman Institute, respectively. Dr. Logan practices in Denver, CO, and serves as Team Physician for Men's USA Lacrosse & as a Team Physician for U.S. Ski & Snowboard. Dr. Bassett is the director of the Women’s Sports Medicine Center at the Orthopedic Institute of New Jersey and practices across northern NJ, primarily in Morris and Sussex Counties.
Together, they will bring monthly conversations on how to care for athletes of all ages and levels of play, with a healthy mix of cutting-edge science and real-world application.
The Sports Docs Podcast
181: Overtime – Secondary Injury after ACL Reconstruction in Professional Soccer Players
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The FIFA World Cup and ACL injuries remain one of the most impactful injuries in professional soccer. While much of the discussion around ACL reconstruction focuses on graft choice, rehabilitation, and return-to-play timelines, a new study published in the American Journal of Sports Medicine highlights an often-overlooked challenge: secondary muscle injuries after athletes return to competition.
In this episode of Overtime with The Sports Docs, Drs. Ashley Bassett and Catherine Logan review the newly published article, "Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer." The study examines the incidence, timing, and impact of muscle injuries following ACL reconstruction in elite soccer players and explores how these injuries affect performance, playing time, and even market value.
The findings reinforce an important principle in sports medicine: return to play is not the finish line—it is only the next phase of recovery.
Key Discussion Points
Understanding ACL Injuries in Soccer
- Common mechanisms of ACL injury in soccer
- Why cutting, pivoting, deceleration, and landing place soccer players at particularly high risk
- The career implications of ACL injuries in professional athletes
ACL Reconstruction Graft Options
- Bone-Patellar Tendon-Bone (BTB) autograft
- Hamstring tendon autograft
- Quadriceps tendon autograft
- Advantages and disadvantages of each graft choice
- Why allograft tissue is generally avoided in elite athletes
Modern Return-to-Play Decision Making
- Moving beyond time-based return-to-play criteria
- Strength testing and limb symmetry
- Hop testing and movement analysis
- Neuromuscular control assessment
- Psychological readiness for sport
- Ongoing graft maturation and biologic healing
Study Review: Secondary Muscle Injuries After ACL Reconstruction
The authors evaluated professional male soccer players from Europe's top leagues who underwent ACL reconstruction between 2020 and 2023 and compared them with matched healthy controls.
Key findings included:
- 32.5% of ACL-reconstructed players sustained a secondary muscle injury within one year of return to play
- Only 12.5% of matched controls experienced muscle injuries
- ACL-reconstructed athletes were more than twice as likely to sustain a muscle injury after return
Most Common Secondary Injuries
- Hamstring strains (42%)
- Quadriceps strains (32%)
- Calf injuries (16%)
- Adductor injuries (11%)
Notably, nearly 70% of injuries occurred on the reconstructed side, suggesting persistent deficits may contribute to injury risk.
The Highest-Risk Window
One of the most important findings:
- Nearly 58% of all secondary muscle injuries occurred between 3 and 6 months after return to competition
This period may represent a critical vulnerability window when athletes are increasing match exposure, training volume, and competition demands.
The Importance of the 9-Month Rule
The strongest predictor of secondary muscle injury was early return to play:
- Athletes returning before 9 months after ACL reconstruction had nearly a fivefold increased risk of secondary muscle injury
This study adds to the growing body of evidence supporting delayed, criteria-based return to sport rather than return based solely on time.
Performance and Career Impact
Players who sustained secondary muscle injuries experienced:
- Reduced playing time
- Fewer minutes on the field
- Decreased participation metrics
- Declines in overall performance
The study also demonstrated significant reductions in player market value among athletes who experienced secondary injuries, highlighting the financial and career implications of incomplete recovery.
Strengths and Limitations of the Study
Strengths
- Matched-control design
- Focus on elite professional soccer players
- Inclusion of performance metrics and market value outcomes
- Real-world relevance for sports medicine clinicians and team physicians
Limitations
- Retrospective study design
- Relatively small sample size
- No objective rehabilitation data available
- No information on graft type
- Lack of strength testing, hop testing, or psychological readiness measures
- No workload or GPS tracking data
Clinical Takeaways
- ACL recovery extends well beyond return to competition.
- Return to play should be viewed as a milestone, not the endpoint.
- The first 3–6 months after return may represent the highest-risk period for secondary injury.
- Continued strength training, neuromuscular training, and workload monitoring remain essential after athletes resume competition.
- Returning before 9 months after ACL reconstruction may substantially increase the risk of secondary muscle injury.
- Successful ACL recovery is not simply about returning to sport—it is about staying healthy and performing at a high level after return.
Article Discussed
"Secondary Muscle Injuries and Performance Decline After Anterior Cruciate Ligament Reconstruction in Professional Soccer"
Published in the American Journal of Sports Medicine (AJSM), 2026.
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Our Hosts:
Ashley Bassett, MD & Catherine Logan, MD, MBA / www.cosportsmedicine.com
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